Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
EuroIntervention. 2018 Feb 2;13(15):e1756-e1763. doi: 10.4244/EIJ-D-17-00584.
Limited information exists describing the results of transcatheter aortic valve replacement (TAVR) in patients with symptomatic severe non-calcific aortic stenosis (AS). We aimed to compare procedural, echocardiographic, and clinical outcomes among patients with non-calcific AS with those of senile calcific AS undergoing TAVR.
We retrospectively identified patients with non-calcific AS who received TAVR with self-expanding transcatheter heart valves in our centre. Clinical and echocardiographic outcomes, and post-procedural multi-detector computed tomography (MDCT) measures were compared to those in patients undergoing TAVR for calcific AS. Among 136 patients, 21 patients (15.4%) with native leaflet thickening and minimal calcification were identified (non-calcific group). The patients were significantly younger in the non-calcific group (70.0 [64.0-75.5] vs. 75.0 [69.0-78.0] years) with comparable STS-PROM scores (6.7 [4.8-8.9] vs. 8.2 [4.8-10.9] %). Predilation was performed less frequently (42.9% vs. 93.9%) and post-dilation more often (71.4% vs. 42.6%) in the non-calcific group. Both 30-day and one-year mortality were similar between groups (0% vs. 7.8% and 0% vs. 17.6%). Rates of post-implantation paravalvular leak ≥mild at six months (17.6% vs. 25.7%) were comparable despite lower implantation depth among non-calcific AS patients (10.9±5.7 vs. 7.2±4.3 mm) on post-implantation MDCT.
TAVR with self-expanding transcatheter heart valves appears to be safe and effective in patients with non-calcific AS.
目前关于经导管主动脉瓣置换术（TAVR）治疗有症状的重度非钙化性主动脉瓣狭窄（AS）患者的研究结果有限。本研究旨在比较非钙化性 AS 患者与老年钙化性 AS 患者行 TAVR 的手术、超声心动图和临床结局。
我们回顾性分析了在我院接受自膨式经导管心脏瓣膜 TAVR 的非钙化性 AS 患者。比较了非钙化性 AS 患者与钙化性 AS 患者的临床和超声心动图结局，以及术后多排螺旋 CT（MDCT）检查结果。在 136 例患者中，有 21 例（15.4%）患者存在瓣叶增厚和轻微钙化（非钙化组）。非钙化组患者明显更年轻（70.0 [64.0-75.5] 岁 vs. 75.0 [69.0-78.0] 岁），STS-PROM 评分相近（6.7 [4.8-8.9] vs. 8.2 [4.8-10.9]%）。非钙化组预扩张的比例较低（42.9% vs. 93.9%），后扩张的比例较高（71.4% vs. 42.6%）。两组患者的 30 天和 1 年死亡率相似（0% vs. 7.8%和 0% vs. 17.6%）。尽管非钙化性 AS 患者的植入深度较浅（10.9±5.7 vs. 7.2±4.3 mm），但两组患者术后 6 个月时≥轻度的瓣周漏发生率相当（17.6% vs. 25.7%）。
自膨式经导管心脏瓣膜 TAVR 治疗非钙化性 AS 患者是安全有效的。
